Bull case
Alnylam Pharmaceuticals is positioned as a differentiated RNAi leader with a durable commercial base in ATTR-CM, supported by AMVUTTRA’s broad label, the underpenetrated nature of a market Alnylam estimates at ~200,000 U.S. patients and ~500,000 globally, and a cardiology channel that is already maturing through buy-and-bill access. Its outlook is further strengthened by a broadening pipeline and partner assets, including zilebesiran with Roche and LEQVIO’s validation of prevalent-disease siRNA commercialization, while management’s view that ZENITH could support a 15% to 20% MACE reduction underscores meaningful second-franchise potential in cardiovascular disease. Even with net price normalization pressure, the company’s demand trends, improving prescriber and payer receptivity, and nucresiran’s favorable economics support expanding revenues, with the TTR franchise modeled to exceed $20.5 billion in peak annual revenue by 2040.